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Review Of Tomorrow's Doctors
- 1. Review of Tomorrow’s Doctors Dr Mairi Scott General Medical Council
- 3. General Medical Council: purpose ‘to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine’
- 4. Our four functions Education Registration Fitness to Practise Standards for doctors.
- 5. Medical School (4-6 years) F1 year (1 year) F2 year (1 year) Specialty/ GP training (3-8 years) Specialist/G P register Provisional registration Full registration Certificate of completion of training (CCT) Medical School (4-6 years) F1 year (1 year)Career stage Employment/ regulatory status Student, not licensed Employed, in training, licensed by GMC Employed, licensed Structure of UK education and training Education standards The New Doctor PMETB standards Tomorrow’s Doctors
- 6. The GMC’s role in medical education Promotes high standards Currently covers undergraduate education and the first year of training after graduation (F1) Quality assures delivery of standards and outcomes: 32 UK medical schools and F1 PMETB to be merged with GMC from 2010 (and GMC will then regulate undergraduate, postgraduate and continued practice) Co-ordinates all stages of medical education
- 7. Tomorrow’s Doctors Sets standards for knowledge, skills and behaviours of medical graduates Provides a framework for UK medical schools for their own curricula/schemes of assessment First published 1993 Last reviewed & published 2003 Stress on communication skills and integrated learning.
- 8. Why review Tomorrow’s Doctors? Changes Foundation Programme PMETB Pressures due to student numbers, EWTD, patient throughput, move from old-style ‘firm’, community-based training Patient and employer expectations Challenges, real or perceived Prescribing and practical skills Scientific knowledge Professionalism, leadership, team-working Assessment.
- 9. Sources for the review QABME – eg. Assessment, clinical placement experience, teacher and assessor training, programme and quality management GMC guidance – GMP, Medical Students, Gateways Educational frameworks – Tuning, Scottish Doctor, Foundation Programme, PMETB Engagement – educational bodies, doctors/students, patients/public, employers Research – Dr Jan Illing, How prepared are medical graduates to begin practice?
- 10. Dr Jan Illing’s findings UK students looked forward to ‘being a doctor’. While communication is a strong area at graduation, F1s were under-prepared for some complex communication tasks. Other clinical skills are well practised, but not in contexts which sufficiently mimic the clinical environment. Knowledge of non-clinical areas such as legal and ethical issues, and the operation of the NHS, was lacking at the start of F1. Prescribing was a significant area of under- preparedness.
- 11. New Tomorrow’s Doctors – structure Tomorrow’s Doctors Outcomes for graduates Standards for delivery of teaching, learning and assessment
- 12. Overarching outcome ‘Medical students are tomorrow’s doctors. In accordance with Good Medical Practice, graduates will make the care of patients their first concern, applying their knowledge and skills in a practical and ethical manner and using their ability to provide leadership and to analyse complex and uncertain situations.’
- 13. Outcomes for graduates Overarching outcome The doctor as a scholar and scientist The doctor as a practitioner The doctor as a professional
- 14. Outcomes for graduates 16 outcomes (all with more detailed lower-level outcomes) Appendix listing 15 diagnostic procedures, 12 therapeutic procedures and 5 general aspects of practical procedures Responding to concerns about basic sciences, prescribing, diagnosis, ethics and law, team- working, improving healthcare…
- 15. Standards for delivery of teaching, learning and assessment Standards for delivery Patient safety Quality assurance, review and evaluation Equality, diversity and opportunity Student selection Design & delivery of curriculum including assessment Support & develop- ment of students, teachers & local faculty Manage- ment of teaching, learning and assessment Educational resources and capacity Outcomes
- 16. Standards for delivery: some key themes Patient safety Practical experience: Placements planned and structured Agreements between schools and providers Student Assistantships Shadowing and induction into F1 Assessment Student support, health, equality Quality control and input from patients and employers.
- 17. Next steps Publication on 1 September 2009 Quality assurance: Annual return from schools Regional workshops Consultation on QA options. PMETB merger with GMC in April 2010 TD outcomes and standards to apply from 2011-12
- 18. Striking a fine balance (1) ‘The modern student never learns anything about a thorough and full physical examination, but relies entirely on reports from special departments.’ Henry Robinson, 1944 (cited in Peter Rubin, ‘Not what we used to be’, BMJ 2008;337:a2905)
- 19. Striking a fine balance (2) ‘The burden we place on the medical student is far too heavy…A system of medical education that is actually calculated to obstruct the acquisition of sound knowledge and to heavily favour the crammer and the grinder is a disgrace.’ Thomas Huxley, 1876 (cited in Tomorrow’s Doctors, 1993)
Hinweis der Redaktion
- F1 and F2 in new Foundation Programme with UK-wide curriculum PMETB – Postgraduate Medical Education and Training Board TD – Tomorrow’s Doctors Currently students acquire first provisional and, after F1, full registration. From 16 November, they will also acquire a licence to practise.
- <number> QABME – Quality Assurance of Basic Medical Education QAFP – Quality Assurance of Foundation Programme
- The General Medical Council (GMC) sets the standards and outcomes for basic medical education in the United Kingdom (UK). This covers undergraduate education and the first year of training after graduation. For undergraduate medical education the standards for the knowledge, skills and behaviours that medical students should learn are set out in our guidance Tomorrow’s Doctors. These standards provide the framework that UK medical schools use to design their own detailed curricula and schemes of assessment. Additionally, the standards set out in Tomorrow’s Doctors are also those against which the quality of undergraduate teaching and assessments are judged by our Quality Assurance of Basic Medical Education (QABME) programme of visits to all medical schools. These visits ensure that medical schools are teaching the required skills and knowledge to the right standard. The GMC last reviewed/published these standards in 2003. TD has a high international reputation and is well known for its emphasis on communication skills and integrated learning.
- We have been reviewing TD since 2007. The creation of the Foundation Programme introduced a national curriculum for the period after graduation, for which all UK graduates need to be prepared. In its short life PMETB has introduced a new approach to standard setting and quality assurance in postgraduate training. Student numbers have significantly increased, partly due to the establishment of 4 new medical schools. At the same time training on clinical placements on the apprenticeship modelled has been compromised by the EWTD, shorter hospitals stays for patients and the decline of the traditional firm. And the expectations of patients, and therefore employers, have continued to rise. In addition UK medical education and the current TD have been criticised. It’s been alleged that new graduates sometimes have poor prescribing and practical skills. Some doctors allege that new graduates lack basic scientific knowledge. There has been a lot of interest in the nature of professionalism and the role of doctors in team-working and providing leadership. Also there has been a lot of interest in assessment methods and some debate on whether the UK should introduce a national examination.
- The review of TD has drawn on the findings from the GMC quality assurance process. For example, assessment has repeatedly been an area of concern. Also we have considered recent GMC publications – the new edition of GMP, guidance on professional values and fitness to practise for medical students, and the Gateways guidance on supporting medical students with disabilities. We have carefully mapped our proposals against existing frameworks including the Tuning competences, The Scottish Doctor, the Foundation Programme curriculum and the standards set by PMETB for postgraduate training. For Tuning see http://www.tuning-medicine.com/index.asp: “The Tuning Project began in 2000 as an initiative funded by the European Commission to develop common core learning outcomes/competences for degree programmes in Europe. It aimed to promote harmonisation in the Higher Education sector in support of the Bologna Declaration and subsequent developments. Beginning in 2004, the Tuning (Medicine) Task Force has now generated and gained widespread consensus on a set of learning outcomes for primary medical degree qualifications in Europe…” We have thoroughly engaged with the GMC’s key interest groups. And we have commissioned research, particularly from Dr Jan Illing and colleagues on the preparedness of the UK graduates. This important research has been published on the GMC website. In particular…
- Jan Illing’s research report is available on the GMC website.
- New structure separates out the standards for delivery (apply to medical schools) from the outcomes we expect graduates to achieve
- Basic sciences – para 8 Prescribing – para 17 Diagnosis – para 14 Ethics and law – para 20 Team working – para 22 Improving healthcare – para 23
- Standards as used for postgraduate training (PMETB) and the Foundation Programme (GMC and PMETB).
- Patient safety – Domain 1 Practical experience – discussed across various domains but especially Domain 5 para 84 and paras 103-110 Assessment – paras 85-90 and 111-121 Student support – paras 123-125 and 130-136 Student health – para 126 and paras 137-144 ‘Equality, diversity and opportunity’ – Domain 3 Quality control and input from patients and employers feature at various points in Domains 2, 7 and 9.
- The impact of the new Tomorrow’s Doctors will be evaluated through the Quality Assurance of Basic Medical Education. Medical schools will be required to complete an Annual Return for 2009/10 that will generate qualitative information about schools’ progress and plans for implementation as well as quantitative and comparable data for benchmarking. The GMC will also organise a series of regional workshops, primarily in April-May 2010, to provide opportunities for medical schools, employers and postgraduate deaneries, among others, to discuss collaboration to date, challenges and responses, and plans or opportunities for joint working to implement Tomorrow’s Doctors. We will also develop for consultation a set of options for the systematic quality assurance of medical schools from 2010 and a measures tool to extrapolate the requirements in Tomorrow’s Doctors and set out how the GMC will test whether each standard is being met. The review raised several issues that could not be fully resolved through changes to the text of Tomorrow’s Doctors. Potential projects and topics for further consideration include: The development of a list of common conditions likely to be encountered by Foundation Programme doctors to be covered in curricula. The development of supplementary guidance on assessment and on external examiners, research into the assessment of professionalism and the consideration of other options for ensuring appropriate consistency in assessment. The development of supplementary guidance on Student Selected Components. The development of supplementary guidance on reasonable adjustments to the competences set out in Tomorrow’s Doctors, analysis of the competences required of F1 doctors, policy development in relation to the competences that may be required in specific rotations in the Foundation Programme and consideration of the statutory framework for medical education and training in relation to individuals with disabilities. The development of supplementary guidance on supervision, Student Assistantships and electives. The development of supplementary guidance setting out standards for undergraduate teachers and trainers. Research into how best to develop effective team-working. Consideration of options for a greater GMC role in relation to student selection and widening participation. The development of guidance on shadowing and induction into the Foundation Programme and the NHS and support for UK-wide arrangements for periods in which final year students can shadow the F1 doctor in the post they will take up. Review of the information that should be shared between educational providers, graduates’ employers and the GMC in relation to individuals’ knowledge, skills and behaviour, and the confidentiality safeguards that should apply.